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Plant Risk Assessment Template

This plant risk assessment addresses physical and health hazards that employees are prone to while performing their daily duties. Some of these hazards include the risk of entanglement, radiation poisoning, explosion, and dismemberment—to name a few. Depending on the type of plant and the nature of the work, certain risks are higher than others. Be prepared to handle any expected or unexpected dangers with this checklist, and keep your personnel safe.

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Plant Risk Assessment Template

Plant Information

Plant Name

Plant Type/Specialty

Plant Address


Supervisor Name & Title

Worker’s Name(s) & Title(s)

Plant Task Description

Frequency Rating (3-Daily/Frequently, 2-Monthly/Occasionally, 1-Quarterly/Rarely) Severity Rating (3-Fatality/Catastrophic Property Damage, 2-Lost Time Injury/Major Property Damage, 1-Medical Aid/Minor Property Damage) Probability Rating (3-Reasonably Probable, 2-Remote, 1-Extremely Remote)

Task Analysis

Task Description

Attach Photo of Hazard

Existing or Potential Hazards

Person(s) at Risk

Health and/or Safety

Type of Hazard




Priority Rating

Current Hazard Control Measures

Hazard Control Required or Improvement Recommended

Assigned To:


Additional Comments or Concerns

Additional Photos

Date & Time

Supervisor's Full Name & Signature

Employee(s) Full Name & Signature

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